MEDICARE: MR. MICHAEL NEBEKER MA 60771411

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	60771411	WA

General Provider Information

NPI Number	:	1871015321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL NEBEKER MA 60771411

Provider Business Mailing Address
First Line	:	2130 97TH DR SE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-4730
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2130 97TH DR SE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-4730
Country	:	US
Telephone Number	:	425-359-2734
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2017
Last Update Date	:	07/16/2017

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